COPD

 

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes a decline in lung function over time. The disease has three traits that must be present to be diagnosed:

  • Emphysema:  This disease process causes damage to the alveoli (tiny air sacs) in the lungs.  This manifests as lung hyperinflation and a reduction in gas exchange on diagnostic testing.

  • Chronic bronchitis:  This causes a chronic inflammation of the airways.  This manifests as chronic cough and increased sputum production.  These symptoms must be present for three consecutive months in two consecutive years to be diagnosed as chronic bronchitis.

  • Airway obstruction:  This first manifests as wheezing and increased shortness of breath.  A pulmonary function test can diagnose and quantify the extent of the problem.

 

The first step in caring for COPD is diagnosing and quantifying the problem.  A treatment plan can then be tailored to each patients specific needs.

 

SYMPTOMS

Symptoms of COPD usually manifest gradually over time.  This often begins with increased frequency of respiratory illnesses and symptoms like coughing, intermittent wheezing, increased mucus production, decreased exercise tolerance, and an increased work of breathing.  This symptom cluster often mimics that of chronic bronchitis.

Other signs of COPD include:

  • Enlarged glands

  • Blue tint to skin around the lips or fingernails (cyanosis)

  • Decreased oxygen saturation (SPO2)

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CAUSES AND RISK FACTORS

Age and smoking account for more than 85% of the risk of developing COPD.  COPD is caused by:

  • Smoking

  • Obesity

  • Exposure to irritants for prolonged periods (job related)

  • In rare cases Alpha-1 Antitrypsin Deficiency (A1AD)

 

DIAGNOSIS

The best place to start for diagnosing and treating COPD is a review of symptoms with your physician. 

Some helpful tests include:

  • Pulmonary Function Test (PFT):  This test involves measuring different aspects of the lungs and can be performed in the office to diagnose and quantify the extent of the problem.  COPD most often shows airway obstruction, larger volumes than normal, and an impairment in gas exchange.

  • Arterial blood gas:  Blood is taken from an artery.  Measurements are performed to evaluate how well your lungs are able to get oxygen into the bloodstream and carbon dioxide (CO2) out of the bloodstream.

  • Chest X-ray:  Chest X-rays can be useful in evaluating the size of the lungs and the density of tissues within the lung.  Often, people with COPD will show enlarged or "hyperinflated" lungs on imaging.  This is a result of "air trapping" that is caused by damage to the alveoli and/or airway obstruction.

  • Advanced imaging (CT Scan/MRI):  Advanced imaging can be used to rule out other disease processes.

 

TREATMENT

Although there is no cure for COPD, with proper treatment and a commitment to a healthy lifestyle you can minimize your symptoms and frequency of exacerbations.  Treatments include:

  • Inhaled respiratory medications which include:

    • Beta agonists:  Albuterol is an example of a beta agonist.  These medications cause the smooth muscle encircling the airways​ to dilate.  This opens up the airway and allows air to pass easier, reducing the work of breathing and alleviating symptoms like wheezing.  Short acting beta agonists are RESCUE MEDICATIONS!

    • Anticholinergics:  Atrovent is an example of an anticholinergic.  These medications prevent the smooth muscle encircling the airways from returning to a relaxed state.  This helps to keep the airway open.  Anticholinergics work best in conjunction with a beta agonist.

    • Steroids:  Pulmicort is an example of an inhaled steroid.  These medications reduce the inflammation within the airways to help air move easier and reduce the work of breathing.  Steroids work best when paired with a long acting beta agonist and/or a long acting anticholinergic.

    • Mucolytics:  Mucinex is an example of a mucolytic.  These medications help to thin secretions so that they are easier to cough up.  This helps to keep the lungs clear and prevent chronic infections.

    • Flu and pneumonia shots:  It is very important for people with COPD to get their yearly shots.  COPD puts them at a higher risk for more frequent infections but also a greater severity when infected.  Staying up to date with these shots will help to prevent more severe illness.

    • Oxygen:  If testing shows that you have a low oxygen saturation (SPO2)

  • Smoking cessation:  If you are a smoker, this is the most important step for you to take.  Smoking is the biggest risk factor for developing COPD, and also the biggest obstacle to optimizing your respiratory function after being diagnosed with COPD.  Your physician can help you develop a plan for quitting in addition to helping you find resources to be successful.

  • Identifying and minimizing triggers:  People with COPD often have sensitive airways.  They will find that certain things may cause them to have difficulty breathing.  The smell of bleach or strong perfumes are good examples.  Identifying triggers and then either removing them or minimizing contact with them is paramount.

  • Maintaining a healthy weight:  The lungs job is to get oxygen into the body so that the cells can make energy and carbon dioxide out of the body as it is the waste produced from the creation of that energy.  The more mass you have, the more cells require oxygen and the more cells produce waste that needs to be expelled.  Therefor, the more mass you have the harder your lungs have to work to do their job.

  • Pulmonary Rehab:  If you have a COPD exacerbation or have a more advanced COPD, you may qualify for pulmonary rehab.  Pulmonary rehab takes place in a fitness center/gym setting and is overseen by medical professionals.  They will help you determine the proper place to start, in terms of activity and intensity level, and help you make a plan to improve your cardiopulmonary performance.  Not only does this help to optimize your lung function while attending, but gives you the tools to maintain that function after it has ended.

COPD is a long-term condition and it is very important to get on a treatment regimen and follow it as prescribed.  If you smoke, talk to your physician about getting help with quitting.  Identify your triggers, and work to minimize your exposure to these triggers.  Learn to control your breathing utilizing deep breathing and relaxation techniques.